Health Insurance Premium Payment (HIPP) Program
If you are enrolled in BadgerCare Plus or the Medicaid Purchase Plan (MAPP) and your employer offers health insurance, you may be eligible for the Health Insurance Premium Payment (HIPP) Program. The Wisconsin Department of Health Services (DHS) HIPP Program can help you afford health insurance through your employer.
HIPP will pay for:
- Your family's monthly premium, as well as the coinsurance and deductibles associated with the employer-sponsored health insurance plan for BadgerCare Plus or MAPP members.
- Any BadgerCare Plus or MAPP covered services not covered by the employer-sponsored health plan. These services will be paid through BadgerCare Plus or MAPP
Enrolling in HIPP is voluntary. If you choose not to enroll in HIPP, even if you are eligible, you will still have access to BadgerCare Plus or MAPP.
You may have to pay a small BadgerCare Plus or MAPP copayment for services received. You don’t have to pay a copayment if you are:
- Under 18 years old.
- Receiving pregnancy related services
- Otherwise exempt (for example, if you are a tribal member)
You may be eligible for the HIPP Program if all of the following are true:
- One of your family members who is in BadgerCare Plus or MAPP is employed, and their employer offers a family health plan. It must be a major medical plan that at least covers physician services, like seeing a primary health care physician.
- None of your family members are currently covered by any employer-sponsored family health plan.
- The employer pays between 40 percent and 80 percent of the cost of the monthly premium for the health plan.
- It is more cost effective than BadgerCare Plus or MAPP coverage for your family.
If you are eligible, you will have the choice to enroll in HIPP.
If you are not eligible, you will not have the option to enroll in HIPP. However, you will continue to be enrolled in BadgerCare Plus or MAPP.
How eligibility is determined
If the employer reports that your family has access to health insurance, DHS will send a HIPP Employer Verification of Health Insurance Coverage form to the employer. This form is used to gather more information about the type of health insurance offered, the cost of the plan, and the employer's share of the premium.
While eligibility is being determined, your family will be enrolled in BadgerCare Plus HMO coverage. If you are a MAPP member, you are not required to enroll in an HMO for coverage but you can choose to if you want to.
How to enroll
- DHS will let you know if you are eligible for the HIPP Program, and that HIPP will pay your share of the employer-sponsored health insurance premium.
- DHS will help you enroll in the employer-sponsored health insurance plan as soon as possible. You will not have to wait until the next open enrollment period.
- If the employer offers more than one cost-effective health insurance plan, you will be able to choose the plan you prefer. DHS can provide information to help you choose.
Paying the employer-sponsored health insurance premium
DHS will work with you and the employer to set up the most convenient way to pay the health insurance premium. There are three options:
- The employer withholds from your wages (this is the most common). You will send a copy of your check stub to DHS that shows the health insurance premium deduction. DHS will mail you a check for your share of the cost of the employer-sponsored health insurance premium.
- The employer directly pays the premium without any withholding from your wages. DHS will mail a check to the employer for your share of the employer-sponsored health insurance premium.
- DHS directly pays the premium to the insurance company. DHS will mail a check to the insurance company for your share of the employer-sponsored health insurance premium.
For more information
For more information about BadgerCare Plus, MAPP, or the HIPP Program:
- Visit the BadgerCare Plus webpage.
- Visit the MAPP webpage.
- Call Member Services at 1-800-362-3002.
- Contact your agency.